The latest tool to help reduce chronic pain sounds like it belongs in a video game collection: virtual reality, or VR. It’s a computer-generated three-dimensional environment you can see with special goggles — and it’s gaining traction as a promising therapy.
In 2021, the FDA approved a prescription home-use VR device to help reduce chronic low back pain, and hospitals have been researching VR’s effects on pain relief.
“In the past, a lot of providers were using opioids as a way to treat chronic pain. As has become clear in recent years, opioids have many downsides, and providers are thirsty for alternative treatments. That’s why there’s increasing interest in this technology, and that’s why we’re studying it,” says Dr. David Binder, a physiatrist and director of innovation at Spaulding Rehabilitation Hospital in Boston.
Virtual reality experience
VR is an immersive technology that makes you feel as if you’re in another world. While sitting comfortably, you put on a VR headset, which are screen-goggles that give you a 360-degree view of a virtual environment. You can look anywhere in the virtual space — up, down, left, right or behind — and you can hear sounds from speakers in the headset or headphones.
In a video game, you might put on a VR headset to ride on a virtual roller coaster. You’ll see the track ahead of you, the amusement park to the sides, and the sky above. You’ll experience the thrill of seeing your car bolt forward, twist or turn — all while hearing the rattling of the car on the track and the shouts of other riders.
VR for chronic pain
Unlike exciting VR video games, VR for pain reduction intends to calm you, often with serene nature settings, such as a grassy field with a brilliant blue sky and a rolling stream nearby. You might hear sounds such as birds chirping and water gently bubbling along rocks. And the environments aren’t always computer-generated; some are videos of real places.
VR devices for chronic pain reduction incorporate other features as well, such as a narrator’s voice guiding the wearer to take in the virtual surroundings, do breathing exercises, redirect negative thoughts about pain or learn about pain responses.
In hospital settings, clinicians are there to help you understand and reinforce the concepts in VR treatment sessions.
How VR might help chronic pain
The strategies used in VR for chronic pain reduction can include mindfulness (focusing on the present moment), meditation, guided imagery or cognitive behavioral therapy (redirecting negative thoughts to positive ones) — all methods used to control stress and mood.
“Stress, anxiety, depression and fear all contribute to pain,” Binder says. “A lot of evidence suggests that if you’re able to treat those, you can help reduce pain.”
It could also be that VR and its many stimuli simply distract your brain from receiving pain signals.
“We already take advantage of this wiring all the time. For example, if you hit your elbow by accident, and it hurts, you rub the elbow and it feels better. You’re tricking the brain by producing the sensory reaction of touching the elbow, which cancels some pain signals,” Binder says.
Evidence of effectiveness
The bulk of the evidence about VR for pain deals with treating sudden, severe pain — for example, using VR to distract people undergoing burn treatments — or pain after surgery, or during labor or cancer treatment.
While there’s not yet a lot of evidence that being in a VR environment reduces chronic pain, some studies are encouraging.
For example, the evidence that swayed the FDA to approve the VR device for chronic low back pain (EaseVRx) was a randomized trial involving 179 people. Half used the three-dimensional VR device, and half used a sham device (with only a two-dimensional environment). After eight weeks of treatment, pain levels were reduced by more than half in 46% of participants using the VR device compared with 26% of the other group.
Availability of the technology
The back pain VR device requires a doctor’s order. It’s not covered by insurance, and Binder doesn’t anticipate that any VR device for chronic pain will be covered until VR becomes mainstream.
However, there are a number of VR devices with pain relief programs (not FDA-approved) available for purchase either online or through private physical therapy practices.
Some hospitals and rehab centers also use VR for chronic pain.
And if you just want to try the technology, you can buy a VR device (starting at about $300) and download a meditation program for it.
It won’t have the same education and guidance found in a program designed for chronic pain reduction, supervised by a physical therapist. But it probably won’t hurt — as long as you don’t have any conditions that would make VR use dangerous, such as dizziness or balance problems.
Future of VR pain management
It’s too soon to know if VR will become a standard part of chronic pain management.
The answer depends on what happens with research, and how much value VR adds to treatment for chronic pain.
“If VR content shows clear improvement, lower pain scores and faster recovery, and if there’s evidence from respected academic centers, the big technology companies would likely be interested. They’re already investing heavily in VR,” Binder says. “You might see VR being adopted at a level never imagined.”